Thoughts on dealing with depression….

Ok, big subject I know, and by its nature the very word “Depression” covers a multitude of states, but here I am thinking of what would perhaps be better termed clinical depression, that is a mental state that can be diagnosed by a clinician rather than a more general feeling of mental dis-ease that many people experience at some point but that doesn’t require any external intervention from medical professionals. There are a number of causes of depression but broadly these can be broken down into two camps, depression with an external cause i.e. something outside the individual that has a significant detrimental effect on mental health, and those with an internal cause i.e. depression caused by changes in brain chemistry or brain function. Each type of case can be further subdivided but at this point the technical differences become rather semantic for a blog of this type. In essence the consequence of this categorization is that there are a range of treatments available, and given the divergence between potential causes, it should be clear that it is unlikely that a one size fits all solution will be appropriate.

The problem is that often it is just such a one size fits all solution that is offered in the first instance. Often this is in the form of one of the more popular depression medications frequently of the Serotonin receptor reuptake inhibitor class of anti-depressants, and these may or may not make a difference, but whether they do or not, they often have side effects which can worsen of complicate the original condition. It should also be noted that if the cause of the depression is not of a type that is treatable with these medications then the medication may simply be masking the underlying condition. It is often argued that the first step in treating depression, and particularly severe depression is to alleviate some of the symptoms as this can allow the patient a little freedom to begin to address the underlying condition. This may well be the case in some instances but is by no means guaranteed, and in the case of a patient experiencing side effects can in reality make the situation much worse.

This position is not helped by the systems in place within healthcare in the UK. One of the little reported issues with depression is that those with depression are highly likely to miss medication, or to take too much, through poor time awareness, poor self esteem, forgetfulness or lack of co-ordination. It would seem obvious that a patient under medication for depression would at the very least be monitored in terms of missed repeat prescriptions as these are easy indicators of poor medication regime, but this does not happen. The implications of coming off anti-depressant medication unsupervised can be very serious indeed, and it seems incredible that patients are not more carefully monitored. My personal preference would be for initially weekly checkups, with blood tests to monitor chemical levels within the blood and the accuracy of medication consumption. I suspect that this would be laughed at as impractical by the majority of doctors in General Practice but it feels like a minimum to me.

Beyond this start point there should be a more coordinated response between the primary medical practitioner, usually the GP and the mental health support team as there will almost certainly, as the patient moves beyond the crisis stage, a need for more reconstructive support. In an ideal world this support would extend to the immediate family, and most pertinently to a designated carer who would be properly supported in providing specialist support to the patient. Of course by this time anyone in mental health care reading this will be unable to see through the tears of laughter running down their faces, and questioning in what reality there would be a budget for this, but as with intervention for eating dis-orders, alcohol abuse, drug abuse and similar conditions, isn’t there a case that any costs at an early intervention stage are more than recouped in the reduction of costs later when the patient has deteriorated to the point that intervention becomes essential rather than preferable.

It would be interesting to see some analysis of this but of course, it is very difficult to put an accurate cost on how much an individuals treatment would be in five or ten years compared to how much a less complex treatment is now. I guess short-termism is as prevalent in health care as it is in every other walk of modern life….